Editing Phlebotomy

{{short description|Medical procedure involving an incision in a vein}}
{{globalize|date=July 2018}}
{{Infobox medical intervention
| Name        = Phlebotomy
| image       = Phlebotomy-practice-university-of-delaware.jpg
| Caption     = Students practising phlebotomy
| ICD10       =
| ICD9        = {{ICD9proc|38.99}}
| MeshID      = D018962
| OPS301      =
| OtherCodes  =
| HCPCSlevel2 =
}}
'''Phlebotomy''' is the process of making a puncture in a [[vein]], usually in the arm, with a [[cannula]] for the purpose of [[Venipuncture|drawing blood]].<ref name="Openstax Anatomy & Physiology attribution">{{CC-notice|cc=by4|url=https://openstax.org/books/anatomy-and-physiology/pages/18-1-an-overview-of-blood}} {{cite book|last1=Betts|first1=J Gordon|last2=Desaix|first2=Peter|last3=Johnson|first3=Eddie|last4=Johnson|first4=Jody E|last5=Korol|first5=Oksana|last6=Kruse|first6=Dean|last7=Poe|first7=Brandon|last8=Wise|first8=James|last9=Womble|first9=Mark D|last10=Young|first10=Kelly A|title=Anatomy & Physiology|location=Houston|publisher=OpenStax CNX|isbn=978-1-947172-04-3|date=July 28, 2023|at=18.1 An overview of blood}}</ref> The procedure itself is known as a [[venipuncture]], which is also used for [[intravenous therapy]]. A person who performs a phlebotomy is called a '''phlebotomist''', although most doctors, nurses, and other technicians can also carry out a phlebotomy.<ref>{{cite web |title= FAQ |url= http://www.phlebotomy.org/faq |publisher= National Association of Phlebotomists |access-date= 28 December 2014 |url-status= live |archive-url= https://web.archive.org/web/20141228205159/http://www.phlebotomy.org/faq |archive-date= 28 December 2014 }}</ref> In contrast, [[Ambulatory phlebectomy|phlebectomy]] is the removal of a vein.

Phlebotomies that are carried out in the treatment of some [[Hematologic disease|blood disorders]] are known as ''[[Bloodletting|therapeutic phlebotomies]]''.<ref name="Kim">{{cite journal |last1=Kim |first1=KH |last2=Oh |first2=KY |title=Clinical applications of therapeutic phlebotomy. |journal=Journal of Blood Medicine |date=2016 |volume=7 |pages=139–44 |doi=10.2147/JBM.S108479 |pmid=27486346|pmc=4957680 |doi-access=free }}</ref> The average volume of whole blood drawn in a therapeutic phlebotomy to an adult is 1 unit (450–500 ml) weekly to once every several months, as needed.<ref>[https://www.aetna.com/cpb/medical/data/600_699/0652.html Retrieved 17 February 2022.]</ref>

==Etymology==
From {{langx|grc|φλεβοτομία}} ({{lang|grc-Latn|phlebotomia}} – {{lang|grc-Latn|phleb}} 'blood vessel, vein' + {{lang|grc-Latn|tomia}} 'cutting'), via {{langx|fro|flebothomie}} (modern French {{lang|fr|phlébotomie}}).{{cn|date=April 2022}}

==Phlebotomies==
[[File:Drawing_blood_from_a_vein_through_phlebotomy_and_venipuncture.jpg|thumb|Blood is collected from a vein by a phlebotomist]]
Phlebotomies are carried out by phlebotomists – people trained to draw blood mostly from veins for clinical or medical testing, transfusions, donations, or research. Blood is collected primarily by performing [[venipuncture]]s, or by using [[Capillary#Blood sampling|capillary blood sampling]] with<ref>{{Cite journal|last1=Krleza|first1=Jasna Lenicek|last2=Dorotic|first2=Adrijana|last3=Grzunov|first3=Ana|last4=Maradin|first4=Miljenka|date=2015-10-15|title=Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine|journal=Biochemia Medica|volume=25|issue=3|pages=335–358|doi=10.11613/BM.2015.034|issn=1330-0962|pmc=4622200|pmid=26524965}}</ref> [[fingerstick]]s or a [[heel stick]] in infants for the collection of minute quantities of blood.<ref name="pmid21391461">{{cite journal |vauthors=Jeon BR, Seo M, Lee YW, Shin HB, Lee SH, Lee YK | title = Improving the blood collection process using the active-phlebotomist phlebotomy system | journal = [[Clinical Laboratory]] | volume = 57 | issue = 1–2 | pages = 21–7 | year = 2011 | pmid = 21391461 }}</ref> The duties of a phlebotomist may include interpreting the tests requested, drawing blood into the correct tubes with the proper additives, accurately explaining the procedure to the person and preparing them accordingly, practicing the required forms of [[asepsis]], practicing standard and [[universal precautions]], restoring [[hemostasis]] of the puncture site, giving instructions on post-puncture care, affixing tubes with electronically printed labels, and delivering specimens to a laboratory.<ref>{{cite book|title=WHO Guidelines on Drawing Blood|year=2010|publisher=World Health Organization|chapter=Best practices in phlebotomy}}</ref> Some countries, states, or districts require that phlebotomists be licensed or registered.{{cn|date=April 2022}}

A '''therapeutic phlebotomy''' may be carried out in the treatment of some blood disorders (example: [[iron overload|Hemochromatosis]], [[polycythemia vera]], [[porphyria cutanea tarda]]), and [[Hives#Acute versus chronic|chronic hives]] (in research).<ref name="Cook">{{Cite journal|last=Cook|first=Lynda S.|title=Therapeutic Phlebotomy|journal=Journal of Infusion Nursing|volume=33|issue=2|pages=81–88|doi=10.1097/nan.0b013e3181d00010|pmid=20228645|year=2010}}</ref><ref name="Yao">{{cite journal |last1=Yao |first1=Q |last2=Zhang |first2=X |last3=Mu |first3=Y |last4=Liu |first4=Y |last5=An |first5=Y |last6=Zhao |first6=B |title=Bloodletting Therapy for Patients with Chronic Urticaria: A Systematic Review and Meta-Analysis. |journal=BioMed Research International |date=2019 |volume=2019 |pages=8650398 |doi=10.1155/2019/8650398 |pmid=31139656|pmc=6500668 |doi-access=free }}</ref>

===Australia===
In [[Australia]], there are a number of courses in phlebotomy offered by educational institutions, but training is typically provided on the job. The minimum primary qualification for phlebotomists in Australia is a Certificate III in Pathology Collection (HLT37215) from an approved educational institution.<ref name="MySkills">{{cite web|title=Certificate III in Pathology Collection|url=https://www.myskills.gov.au/courses/details?Code=HLT37215|publisher=Australian Government|access-date=14 January 2018|url-status=live|archive-url=https://web.archive.org/web/20180114074101/https://www.myskills.gov.au/courses/details?Code=HLT37215|archive-date=14 January 2018}}</ref>

===United Kingdom===
{{Main|Phlebotomy licensure#United Kingdom}}
In the [[UK]] there is no requirement for holding a formal qualification or certification prior to becoming a phlebotomist as training is usually provided on the job. The [[National Health Service|NHS]] offers training with formal certification upon completion.<ref name="NHS phlebotomy">{{cite web|title=Phlebotomist|url=http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/phlebotomist/|publisher=NHS Careers|access-date=15 September 2014|url-status=live|archive-url=https://web.archive.org/web/20140929061351/http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/phlebotomist|archive-date=29 September 2014}}</ref>

===United States===
{{Main|Phlebotomy licensure in the United States}}
Special state certification in the [[United States]] is required only in four states: [[California]], [[Washington (state)|Washington]], [[Nevada]], and [[Louisiana]]. A phlebotomist can become nationally certified through many different organizations. However, California currently only accepts national certificates from six agencies. These include the [[American Certification Agency]] (ACA), [[American Medical Technologists]] (AMT), [[American Society for Clinical Pathology]] (ASCP), [[National Center for Competency Testing]]/[[Multi-skilled Medical Certification Institute]] (NCCT/MMCI), [[National Credentialing Agency]] (NCA), and [[National Healthcareer Association]] (NHA).<ref>{{cite web |url=http://www.cdph.ca.gov/programs/lfs/Documents/P-LFS-Approved-CertOrg-Exams.pdf |title=Archived copy |access-date=2016-03-16 |url-status=dead |archive-url=https://web.archive.org/web/20160323205518/http://www.cdph.ca.gov/programs/lfs/Documents/P-LFS-Approved-CertOrg-Exams.pdf |archive-date=2016-03-23 }}</ref> These and other agencies such as the American Society of Phlebotomy Technicians also certify phlebotomists outside the state of California. To qualify to sit for an examination, candidates must complete a full phlebotomy course and provide documentation of clinical or [[Medical laboratory|laboratory]] experience.

===South Africa===
In [[South Africa]] learnerships to qualify as a Phlebotomy Technician are offered by many public and private educational institutions as well as by private academies owned up by pathology laboratories (such as Ampath Laboratories, Lancet, PathCare) and healthcare service providers (such as [[Netcare]], [[South African National Blood Service]]). Some of the larger retail pharmacy chains offering in-store clinical services (such as Clicks, [[Dis-Chem]]) also provide training for aspirant phlebotomists. Certification can be obtained from a number of examination and testing institutions. To work as a phlebotomist in South Africa, registration with the [[Health Professions Council of South Africa]] (HPCSA) is required.

==Sample tube types==
{{Table of blood sampling tubes}}

==Draw station==
A phlebotomy draw station is a place where blood is drawn from patients for laboratory testing, transfusions, donations, or research purposes. The blood is typically drawn via [[venipuncture]] or a [[finger stick]] by a healthcare professional such as a [[phlebotomist]], [[nurse]], or [[medical assistant]].<ref>{{cite book |last1=Flynn |first1=John C. |title=Procedures in Phlebotomy - E-Book: Procedures in Phlebotomy - E-Book |date=12 August 2023 |publisher=Elsevier Health Sciences |isbn=978-0-323-93779-5 |url=https://books.google.com/books?id=zhLlEAAAQBAJ&q=%22draw%20station%22 |access-date=21 August 2024 |language=en}}</ref>
The draw station typically includes a padded chair or a bed for patients prone to fainting during blood draws.
Draw stations can be found in various settings, such as hospitals, clinics, blood donation centers, and independent laboratories or as part of [[patient service center]]s (PSC).

==History==
{{main|Bloodletting}}
Early phlebotomists used techniques such as [[Leeches#Medicinal use of biologically sterile leeches|leeches]] and incision to extract blood from the body. Bloodletting was used as a therapeutic as well as a prophylactic process, thought to remove toxins from the body and to balance the [[humorism|humors]]. While physicians did perform bloodletting, it was a specialty of [[barber surgeon]]s, the primary provider of health care to most people in the medieval and early modern eras.

==See also==
* [[Cytotechnologist]]
* [[Injection (medicine)]]
* [[Medical technologist]]
* [[List of surgeries by type]]
* [[Phlebotominae]]
* [[Phlebotomy licensure]]

==References==
{{reflist}}
{{wikt | phlebotomy}}
{{Vascular procedures}}

[[Category:Vascular surgery]]
[[Category:Blood tests]]
[[Category:Phlebotomy]]
[[Category:Laboratory healthcare occupations]]